title: Manual therapy, exercise therapy, or both, in addition to usual care, for osteoarthritis of the hip or knee. 2: economic evaluation alongside a randomized controlled trial.
abstract: OBJECTIVE
  To evaluate the cost effectiveness of manual physiotherapy, exercise physiotherapy, and a combination of these therapies for patients with osteoarthritis of the hip or knee.
  
  
  METHODS
  206 Adults who met the American College of Rheumatology criteria for hip or knee osteoarthritis were included in an economic evaluation from the perspectives of the New Zealand health system and society alongside a randomized controlled trial. Resource use was collected using the Osteoarthritis Costs and Consequences Questionnaire. Quality-adjusted life years (QALYs) were calculated using the Short Form 6D. Willingness-to-pay threshold values were based on one to three times New Zealand's gross domestic product (GDP) per capita of NZ$ 29,149 (in 2009).
  
  
  RESULTS
  All three treatment programmes resulted in incremental QALY gains relative to usual care. From the perspective of the New Zealand health system, exercise therapy was the only treatment to result in an incremental cost utility ratio under one time GDP per capita at NZ$ 26,400 (-$34,081 to $103,899). From the societal perspective manual therapy was cost saving relative to usual care for most scenarios studied. Exercise therapy resulted in incremental cost utility ratios regarded as cost effective but was not cost saving. For most scenarios combined therapy was not as cost effective as the two therapies alone.
  
  
  CONCLUSIONS
  In this study, exercise therapy and manual therapy were more cost effective than usual care at policy relevant values of willingness-to-pay from both the perspective of the health system and society. Trial registration number Australian New Zealand Clinical Trials Registry ACTRN12608000130369.
authors.affiliation: Department of Physical Therapy and Human Movement Sciences, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: D
authors.initials: D
authors.lastname: Pinto
authors.forename: M C
authors.initials: MC
authors.lastname: Robertson
authors.forename: J H
authors.initials: JH
authors.lastname: Abbott
authors.forename: P
authors.initials: P
authors.lastname: Hansen
authors.forename: A J
authors.initials: AJ
authors.lastname: Campbell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D005081:Exercise Therapy / Q000191:economics* / Q000379:methods; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations / Q000191:economics* / Q000379:methods; D009520:New Zealand; D015207:Osteoarthritis, Hip / Q000191:economics / Q000534:rehabilitation*; D020370:Osteoarthritis, Knee / Q000191:economics / Q000534:rehabilitation*; D019057:Quality-Adjusted Life Years; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Cost–benefit analysis; Economic evaluation alongside clinical trials; Exercise therapy; Manual therapies; Osteoarthritis, hip; Osteoarthritis, knee; Randomized controlled trial